Despite more than a decade of heightened attention and extensive efforts to improve patient safety, recent studies find that patient harms remain common in American hospitals. Studies also report that Critical Access Hospitals (CAHs) have higher risk-adjusted 30-day mortality rates compared with non-CAHs and the rates increased between 2002 and 2010. Agency for Healthcare Research and Quality (AHRQ) is actively disseminating TeamSTEPPS, an evidence-based teamwork and team training intervention for improving communication and teamwork skills among health care providers. Our previous research has found that many CAHs struggled with making timely progress with implementing and sustaining TeamSTEPPS. One of the biggest miss-steps was that they initiated the implementation without conducting necessary preparation steps. Once initiated, the limited resource conditions constrained the CAHs' ability to adjust their implementation approach, which often led to the suspension or dismissal of the implementation effort. The objective of this study is to develop a pre-training intervention specifically designed to assist CAHs to prepare for TeamSTEPPS. We will pilot test the intervention in four CAHs and prospectively examine how the intervention influences the process of implementing TeamSTEPPS in these CAHs. We will address three specific aims. The first aim is to design a pre-training intervention to assist CAHs to prepare for TeamSTEPPS implementation. Building on our previous work that identified five key elements to strategic preparation assessing strategic needs, assessing the organizational context, selecting change agents, developing a shared understanding, and specifying implementation goals, we will develop an intervention protocol that specifies key steps and practical guidelines for conducting pre-training preparation. The second specific aim is to conduct the pre-training intervention in four CAHs and prospectively examine the implementation processes in these hospitals. We will recruit and conduct the intervention in four CAHs before they participate in the TeamSTEPPS Master Trainer Training. After the Training, we will make quarterly visits to each hospital to collect data on implementation dynamics (implementation fidelity and focus, change agent efficacy and engagement) and progress (timing and scope of implementation activities). The third specific aim is to evaluate the relationship between the elements of the intervention and the implementation dynamics and progress. We will use both traditional qualitative methods and the Qualitative Comparative Analysis (QCA) to identify integral connections linking specific elements of the intervention to various process outcomes such as implementation fidelity, change agent engagement, and implementation progress. We expect that the proposed intervention, after future refinement and testing, can be used to facilitate TeamSTEPPS implementation in CAHs, and will significant contribute to AHRQ's effort to disseminate this evidence-based program to enhance patient safety.